LEGACY ADVANCED HEALTH LLC NPI 1538651112

NPI Information

  • NPI: 1538651112
  • Provider Name: LEGACY ADVANCED HEALTH LLC
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • Former Legal Business Name: LEGACY ADVANCED HEALTH
  • Address: 9864 GRAND VERDE WAY APT 1507
    BOCA RATON, FL
    ZIP 33428
  • Phone: (561) 563-5446

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NPI Details

LEGACY ADVANCED HEALTH LLC is a general practice in Boca Raton, FL. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee LEGACY ADVANCED HEALTH LLC NPI is 1538651112. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Legacy Advanced Health.

The provider's business location address is:

9864 GRAND VERDE WAY APT 1507
BOCA RATON, FL
ZIP 33428-524
Phone: (561) 563-5446

The provider's authorized official is Pamela Diana Manning .
The authorized official title is Owner/practitioner and has the following contact phone number (561) 563-5446.

The enumeration date for this NPI number is 5/31/2018 and was last updated on 5/31/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeFLORIDAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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